Tag: Diabetes

Younger adults with atrial fibrillation face higher rates of heart failure and stroke

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In a recent study published in the Circulation: Arrhythmia and Electrophysiology, a group of researchers investigated the risk factor (RF) burden, clinical outcomes, and long-term survival among patients with atrial fibrillation (AF) under 65 years of age.

Study: Mortality, Hospitalization, and Cardiac Interventions in Patients With Atrial Fibrillation Aged <65 Years. Image Credit: Nakharin T/Shutterstock.com

Background

AF, the most prevalent heart rhythm disorder in the United States (U.S.), affected an estimated 5.2 million people in 2010, with projections rising to 12.1 million by 2030.

While AF is typically seen in older adults, a growing number of patients are under 65 at diagnosis, representing 10%-15% of cases. This age group faces increasing rates of RFs, such as hypertension, diabetes, and obesity.

Despite their prevalence, the impact of AF on mortality and major clinical events in younger patients remains poorly defined. Further research is needed to clarify the unique clinical outcomes and effective management strategies for younger patients with AF.

About the study

The present study was a retrospective observational cohort analysis at the University of Pittsburgh Medical Center involving patients over 18 years diagnosed with AF.

The diagnosis was confirmed using the International Classification of Diseases (ICD), Ninth and Tenth Revision codes. Patients evaluated between January 2010 and December 2019, were included if they had at least two outpatient visits in internal medicine, family medicine, or cardiology.

Data were extracted from an extensive electronic health record system combined with administrative and other data sources.

This study assessed a range of cardiovascular risk factors and comorbidities, including obesity, smoking history, hypertension, diabetes, and various heart conditions. Detailed information on patient characteristics such as age, gender, and race was gathered, along with data on previous cardiovascular interventions and medication usage at baseline.

The primary outcome measured was all-cause mortality, verified through the Social Security Death Index and supplemented by electronic health record data. The study also looked at secondary outcomes like hospitalizations for cardiovascular events and cardiac interventions that occurred during follow-up.

Statistical analyses involved various tests to compare continuous and categorical variables and utilized Kaplan-Meier survival analysis and Cox proportional hazards models to explore the impact of AF on mortality in patients under 65, adjusting for multiple confounders.

Sensitivity analyses were conducted to consider the effects of various exclusions on the study results.

Study results

The study included 67,221 patients diagnosed with AF, reflecting an average CHA₂DS₂-VASc score of 3.1±1.6. The cohort’s average age was 72.4±12.3 years, with 45% female and 95% white participants. Notably, a significant portion, 26%, were under 65 years at their initial evaluation.

Within the subgroup of patients younger than 65, males were more prevalent, especially in those under 50 (73%) and those between 50 to 65 years (66.3%). This group displayed substantial cardiovascular RFs, including hypertension (55%), diabetes (21%), heart failure (HF) (21%), and dyslipidemia (47%).

Lifestyle RFs such as obesity (over 20% affected) and current smoking (16%) were also significant. Among these younger patients, 4% had a history of stroke, and peripheral vascular disease was present in 1.35%.

Cardiac interventions were common: 3% had an implantable cardioverter-defibrillator, 2% had a pacemaker, 5.5% underwent percutaneous coronary intervention, and 2.5% had prior mitral valve surgery.

Additional comorbidities included obstructive sleep apnea (18%), chronic obstructive pulmonary disease (11%), and chronic kidney disease (1.3%).

At baseline, over half of the patients under 65 were taking anticoagulants, with similar rates for aspirin and significant use of class 1 (6%) and class 3 (17%) antiarrhythmic drugs.

Mortality and hospitalization rates varied by age, with the younger cohort experiencing notably lower mortality rates compared to their older counterparts. In the under-50 age group, the 5-year and 10-year mortality rates were 5.6% and 10.3%, respectively, which approximately doubled in the 50 to 65 age group to 11.5% and 20.8%.

Hospitalization for AF, HF, and myocardial infarction was reported in 31%, 12%, and 2.7% of those under 50, while those figures increased to 38%, 19%, and 4.7% in the 50 to 65 group.

Further analysis revealed multiple cardiovascular RFs and comorbidities independently associated with all-cause mortality among those under 65. HF, peripheral vascular disease, diabetes, coronary artery disease, smoking, and obesity significantly impacted mortality rates.

Notably, chronic kidney disease and chronic obstructive pulmonary disease were also linked to poorer outcomes. Interaction analyses indicated a significant correlation between age and the impact of hypertension and HF on mortality rates.

Comparing the AF cohort with national mortality estimates highlighted a considerably higher all-cause mortality rate among the AF patients, particularly notable in younger males and females. Furthermore, adjusting for cardiac and noncardiac risk factors, AF significantly increased the mortality hazard in patients under 65 compared to a control group without AF.

This population also showed a heightened risk of hospitalization for myocardial infarction, HF, and stroke, underscoring the severe impact of AF in younger patients.

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April 24, 2024
Glucose monitors may misclassify people as being at risk of diabetes

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Continuous glucose monitors were developed for people with diabetes, but are now often touted as having benefits for those without the condition

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Glucose monitors stuck to the arm may be inaccurate when it comes to telling people if they are at high risk of developing diabetes. The devices can suggest different results for whether someone has healthy blood sugar readings from one day to the next, a study has found.

The inconsistencies suggest that more research is needed in people without diabetes before the monitors can be used to give…

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April 23, 2024
Innovative shoe insole technology mitigates the risk of diabetic foot ulcers

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Researchers have developed a new shoe insole technology that helps reduce the risk of diabetic foot ulcers, a dangerous open sore that can lead to hospitalization and leg, foot or toe amputations.

The goal of this innovative insole technology is to mitigate the risk of diabetic foot ulcers by addressing one of their most significant causes: skin and soft tissue breakdown due to repetitive stress on the foot during walking.”

Muthu B.J. Wijesundara, principal research scientist at The University of Texas at Arlington Research Institute (UTARI)

Affecting about 39 million people in the U.S., diabetes can damage the small blood vessels that supply blood to the nerves, leading to poor circulation and foot sores, also called ulcers. About one-third of people with diabetes develop foot ulcers during their lifetime. In the U.S., more than 160,000 lower extremity amputations are performed annually due to complications from diabetic foot ulcers, costing the American health system about $30 billion a year. Those who have foot ulcers often die at younger ages than those without ulcers.

“Although many shoe insoles have been created over the years to try to alleviate the problem of foot ulcers, studies have shown that their success in preventing them is marginal,” Wijesundara said. “We took the research a step further by creating a pressure-alternating shoe insole that works by cyclically relieving pressure from different areas of the foot, thereby providing periods of rest to the soft tissues and improving blood flow. This approach aims to maintain the health of the skin and tissues, thereby reducing the risk of diabetic foot ulcers.”

In an article in the peer-reviewed International Journal of Lower Extremity Wounds, Wijesundara and UTA colleagues Veysel Erel, Aida Nasirian and Yixin Gu, along with Larry Lavery of UT Southwestern Medical Center, described their innovative insole technology. After this successful pilot project, the next step for the research team will be refining the technology to make it more accessible for users with varying weights and shoe sizes.

“Considering the impact of foot ulcers, it’s exciting that we may be able to make a real difference in the lives of so many people,” Wijesundara said.

Source:

University of Texas at Arlington

Journal reference:

Erel, V., et al. (2024). Development of Cyclic Pressure Offloading Insole for Diabetic Foot Ulcer Prevention. The International Journal of Lower Extremity Wounds/International Journal of Lower Extremity Wounds. doi.org/10.1177/15347346241234825.

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April 22, 2024
New insights to optimize telehealth for diabetes care
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Grocery stores, airports and beaches aren’t great places to have telehealth visits with your endocrinologist. But home can be one of the best locations, giving a doctor helpful insights into a patient’s home environment, which can positively impact their care.

This is just one finding shared in a new study published this week in The Journal of Clinical Diabetes.

Researchers interviewed clinicians and staff who provide diabetes care through telehealth across four University of California academic medical centers: UC Davis Health, UCSF Health, UCLA Health and UC San Diego Health. Researchers asked open-ended questions to learn how telehealth is used, challenges faced, helpful practices and plans for the future.

These are critical and timely questions since telehealth remains an important way to provide care in the wake of the COVID-19 pandemic. But there is limited data about how to optimize it for specific types of care. We asked the people who have the most experience in this area to identify best practices which can be used, further studied, and refined moving forward.”

Stephanie Crossen, UC Davis pediatric endocrinologist and senior author of the study

The study suggests several important strategies to improve telehealth operations:
1. Dedicated staff support is essential to obtain data from patients’ devices (like remote glucose monitors) ahead of telehealth visits. This can improve access to care for individuals with limited digital literacy, save clinician time during visits and prevent unnecessary rescheduling of appointments.
2. Efficient workflows around scheduling follow-up visits are needed to ensure people don’t experience lapses in care.
3. Finding the best ways to facilitate team-based diabetes care is key. For a diabetes management telehealth visit, this may include a nurse, dietitian, social worker, pharmacist or educator, in addition to the primary clinician. It is important to create workflows that support this effort.
Interviewees also said telehealth visits can provide a good opportunity to review and discuss the impact of the home environment on diabetes self-care. Through screen sharing, clinicians can also review trends in a patient’s glucose data and discuss daily management successes or challenges.

Finally, those interviewed also noted the need for clear patient guidelines about appropriate timing and physical setting for joining telehealth visits to make them efficient and effective. For example, visits while driving or at a large group event were not advised.

I hope the findings of our study will spark discussion around how we can optimize telehealth and take advantage of its unique capabilities to improve patient care, rather than trying to replicate the in-person visit.”

Sarah Haynes, assistant professor from the UC Davis Department of Pediatrics and lead author of the study

Other study authors are Miriam Sarkisian of the UC Davis Center for Health and Technology; Aaron Neinstein and Polly Teng of UCSF’s Department of Medicine; Jenise Wong of UCSF’s Department of Pediatrics; and James Marcin of UC Davis Department of Pediatrics.

This study was supported by a research award from the Children’s Miracle Network at UC Davis. Crossen also receives support from the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health (NIH) through grant number K23DK125671.

Source:

University of California – Davis Health

Journal reference:

Haynes, S. C., et al. (2024) From Surviving to Thriving: A Qualitative Study of Adapting Telehealth Systems for Specialty Diabetes Care Across Four California Medical Centers. Clinical Diabetes. doi.org/10.2337/cd23-0108.
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April 19, 2024
Optimize postprandial glycemic control with tailored exercise prescriptions
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In a recent study published in Nutrients, researchers elucidate various exercise parameters, such as timing, type, intensity, and volume, influence post-meal glucose responses in healthy and diabetic individuals.

Study: Exercise Prescription for Postprandial Glycemic Management. Image Credit: C_Production / Shutterstock.com

Does exercise timing affect postprandial glucose responses?

Exercise improves blood flow in active muscles and microvascular recruitment, thereby increasing glucose uptake and reducing its levels in the blood. However, nutritional state at the time of exercise is a crucial factor in the fluctuation of blood glucose levels.

Pre-meal exercise induces insulin sensitivity and fat oxidation by promoting glycogenolysis, which subsequently stabilizes blood glucose levels and prevents hypoglycemia. In the prandial state, glucose is primarily derived from exogenous sources.

The timing of exercise after meals plays an important role in managing blood glucose levels after eating. Recent physical activity guidelines for people with type 2 diabetes (T2D) recommends exercising after meals to efficiently control postprandial glucose levels.

The effect of exercise, especially when performed 12-16 hours before eating, is significantly less for acute blood glucose management. However, moderate-intensity aerobic or resistance exercise 20-45 minutes before a meal leads to significantly lower post-meal glucose levels.

Thus, the performance of exercise closer to any meal leads to optimal benefits in glucose management. As compared to pre-meal exercise, post-meal exercise has greater benefits in controlling blood glucose levels for both non-diabetic and diabetic individuals. Several factors, such as exercise intensity and volume, and nutrition status, are responsible for the differential effects of pre- and postprandial exercise.

For healthy individuals, glucose levels peak 30-60 minutes after eating. However, glucose levels peak 60-120 minutes after a meal in people with T2D. Considering findings from multiple studies, postprandial exercise before glucose levels peak has been recommended at approximately 15 and 30 minutes in healthy individuals and people with diabetes, respectively.

Which exercise type Is most effective in maintaining blood glucose levels?

Both aerobic and resistance exercises, particularly in combination, play a significant role in the long-term management of glucose levels in people with T2D. In fact, any form of exercise is recommended to people with T2D to improve their glucose response after a meal.

Among the various forms of exercise, cycling at varied intensities significantly reduces post-meal glucose excursions. Furthermore, a 30-minute moderate-intensity walking, elliptical exercise, cycling, or jogging lowers post-meal glucose peak and three hours of postprandial glucose levels in non-diabetic/healthy people. Alternative exercises, such as stair climbing and descending, also have beneficial effects on glucose management in people with diabetes.

Circuit and traditional resistance training significantly reduce postprandial blood glucose levels. After breakfast, 15-30 minutes of circuit resistance training significantly reduces blood glucose levels in both healthy and diabetic individuals.

Alternative muscle training programs, such as neuromuscular electrical stimulation (NMES), also decrease glycemic levels in both healthy individuals and those with T2D. For optimal benefits, 30 minutes of passive NMES followed by 30 seconds of work with 60 seconds of rest has been recommended. Voluntary muscle contractions in the lower limbs also reduce glucose peaks.

Exercise duration and intensity for optimal postprandial glycemic levels

Exercise volume, duration, and intensity must be suitably customized to accommodate an individual’s capacity. To date, no clear guidelines have been published on the optimal exercise volume to control post-meal glucose levels.

Exercise intensity must be tailored in terms of exercise duration, health condition, personal capacities, and preferences. For example, some people prefer shorter durations of high-intensity exercise, whereas others enjoy a longer session of moderate-intensity exercise.

The most recent guidelines for diabetic people are 45 minutes of exercise at any intensity to improve post-meal glucose management; however, there are many limitations to this recommendation. For example, high-intensity exercise could be challenging to perform shortly after a meal, which could increase gastrointestinal disturbances and hepatic glucose production. Therefore, a better exercise volume prescription is required to improve postprandial glucose responses.

Several studies have shown that exercise duration of 10-120 minutes can positively affect post-meal glucose responses in both non-diabetic and healthy individuals. Exercise sessions of 30-60 minutes have been consistently associated with improvements in postprandial blood glucose levels.

Likewise, 30-minute moderate-intensity aerobic exercise significantly improves postprandial glucose responses similar to that of a 45-minute session. A shorter duration of light-intensity exercise also has beneficial effects on blood glucose levels and glucose peaks, which is comparable to longer durations of exercise.
Journal reference:

Bellini, A., Nicolò, A., Bazzucchi, I., & Sacchetti, M. (2024). Exercise Prescription for Postprandial Glycemic Management. Nutrients 16(8); 1170. doi:10.3390/nu16081170
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April 18, 2024
The role of yogurt in diabetes and obesity prevention
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A recent study published in Frontiers in Nutrition discusses the role of yogurt as a nutritious food in preventing and managing diabetes and obesity.

Study: Yogurt, in the context of a healthy diet, for the prevention and management of diabetes and obesity: a perspective from Argentina. Image Credit: Aquarius Studio / Shutterstock.com

Risk factors for diabetes

Diabetes is a non-communicable chronic disease characterized by persistently high blood glucose levels. In some cases, diabetes can develop due to unhealthy lifestyles, including inadequate diet and lack of physical activity; therefore, obesity is considered a major risk factor for diabetes onset. The prevalence of both obesity and diabetes is exponentially increasing worldwide.

Health benefits of yogurt

Yogurt is a low-calorie fermented dairy product that provides a balanced proportion of proteins, essential nutrients, as well as a range of viable beneficial bacteria. In fact, consuming 100 grams of yogurt each day as part of a healthy diet of 2,000 kcal is responsible for 5% of overall diet quality.

Several nutritional studies have demonstrated that the consumption of yogurt is associated with a reduced risk of obesity, diabetes, osteoporosis, and cardiovascular disease. Yogurt has also been shown to improve gastrointestinal health and proper functioning of the immune system.

Dietary patterns in Argentina

In Argentina, the most recent national survey report indicates that about 52% and 13% of the population has obesity and diabetes, respectively. A decline of about 44% in moderate-to-high intensity physical activity has also been observed in the population as compared to previous surveys. Furthermore, the survey finds that only 6% of the Argentinian population consume recommended amounts of fruits and vegetables, while 22% of the population use tobacco products.

Recent diet-quality surveys in Argentina indicate that the dietary pattern of only 11% of households has a high nutritional density. The food gap, which is defined as the difference between apparent intake and healthy recommendations, is about 60% in high nutrient density vegetable foods and 48% in dairy products.

Thus, improving the nutritional quality of the Argentinian diet can be achieved by reducing food gaps, as well as starchy food and meat intake.

Yogurt intake in Argentina

The current annual consumption of yogurt in Argentina is about four kilograms/person/year, which is a significant reduction from 2012 estimates of 10 kg/person/year. Overall, the consumption of both full-fat and skim yogurt has declined by 44% in the past 10 years in Argentina.

Yogurt is not indicated as a source of viable beneficial bacteria in the dietary guidelines for Argentina. However, in north American and European countries, yogurt is recognized as a nutritious dairy product with significant health benefits.

According to an economic model for yogurt use in diabetes risk reduction in the United Kingdom, the consumption of 100 grams of yogurt each day by adults can lead to 388,000 fewer people developing diabetes in the next 25 years. In the United States, similar levels of yogurt consumption by adults can potentially reduce healthcare costs by billions of dollars.

Yogurt for diabetes management

In 2019, the prevalence of diabetes in Argentina was estimated to be 13%. The anti-diabetic activity of low-fat yogurt could be attributed to its low glycemic load and presence of various nutrients, including proteins, calcium, magnesium, and vitamin D.

Furthermore, certain saturated fatty acids present in yogurt, such as pentadecanoic and heptadecanoic acids, are associated with diabetes risk reduction. In this context, previous studies have predicted that daily yogurt consumption of 50 grams can lead to a 7% reduced risk of diabetes.

Plain or natural yogurt has a lower glycemic index than sweetened yogurt, which could be due to a higher protein to carbohydrate ratio in plain yogurt. The fermentation process involved in yogurt production can reduce carbohydrate bioavailability by converting then into organic acids and polysaccharides.

The viable beneficial bacteria present in yogurt have been shown to improve blood lipid profiles, reduce cholesterol levels, and increase antioxidant status in diabetic patients. Moreover, organic acids present in yogurt, such as lactic acid, can reduce postprandial blood glucose levels and insulinemia.

Yogurt for obesity management

The prevalence of obesity among children and adolescents in Argentina has been estimated to be over 40%. Among adults, the prevalence of obesity is six for every 10 individuals.

Gut microbiota dysbiosis, which is characterized by an imbalance in the composition and diversity of the microbiome, is a major contributor to obesity. Obesity-related alterations in gut microbiota can lead to increased fat deposition, impaired energy balance, increased inflammation, and metabolic dysfunction.

Yogurt can reduce the risk of obesity by replacing less healthy foods with its diverse nutritional components and viable beneficial bacteria. Yogurt can also impact appetite regulation, energy balance, and different anthropometric parameters, including body mass index (BMI).

Epidemiological studies have shown that yogurt consumption is associated with reduced BMI, overall obesity, and abdominal obesity. Yogurt consumption has also been associated with reduced total body and abdominal fat deposition, as well as lower weight gain.

Conclusions

Existing scientific evidence indicates that yogurt consumption could be beneficial for the prevention and management of both diabetes and obesity. The rising prevalence of these chronic diseases throughout the world emphasizes the importance of encouraging people to incorporate yogurt as part of their healthy diet to improve public health and reduce healthcare costs.
Journal reference:

Britos, S., Gonzalez, A. F., Marco, F. F., et al. (2024). Yogurt, in the context of a healthy diet, for the prevention and management of diabetes and obesity: a perspective from Argentina. Frontiers in Nutrition. doi:10.3389/fnut.2024.1373551.
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April 18, 2024
Phase 2 trial reveals Lixisenatide may reduce motor disability in Parkinson’s patients
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A recent study published in the New England Journal of Medicine conducted a trial of lixisenatide to assess its effects in early Parkinson’s disease.

Study: Trial of Lixisenatide in Early Parkinson’s Disease. Image Credit: create jobs 51/Shutterstock.com

Background

Current treatments for Parkinson’s disease are primarily based on dopaminergic replacement therapy and have not convincingly demonstrated effects on disease progression. Further, epidemiological studies have observed increased Parkinson’s disease risk in individuals with type 2 diabetes.

Moreover, some studies have shown a lower prevalence of Parkinson’s disease among diabetes patients treated with dipeptidyl peptidase-4 inhibitors or glucagon-like peptide (GLP)-1 receptor agonists compared to recipients of other medications.

Lixisenatide is a GLP-1 receptor agonist used to treat type 2 diabetes. Its neuroprotective actions have been demonstrated in animal models of Parkinson’s disease and Alzheimer’s disease.

About the study

In the present study, researchers evaluated the disease-modifying effect of lixisenatide in individuals with early Parkinson’s disease. This phase 2, double-blind, randomized, multicenter, placebo-controlled trial was performed in France.

People aged 40–75 diagnosed with Parkinson’s disease within the past three years were recruited. Eligible subjects were treated with a stable, optimized dopaminergic medication regimen for at least a month before starting trial agents.

Participants were randomized to receive lixisenatide or placebo in addition to their standard treatment for Parkinson’s disease.

The trial agent was initially administered at 10 μg/day for 14 days and 20 μg/day for the remainder of 12 months. Subjects continued their existing medication for Parkinson’s disease for the first six months at least.

Clinical assessments were performed at baseline, six-month, and 12-month visits. Subjects were evaluated in an on-medication state based on scores on the Parkinson’s Disease Questionnaire summary index, Movement Disorder Society (MDS)-sponsored revision of the Unified Parkinson’s Disease Rating Scale (UPDRS) parts I–IV, and Montreal Cognitive Assessment.

Besides, subjects were assessed in an off-medication state after a two-month washout period at 14 months.

Fasting blood glucose and insulin levels were measured. Vital signs and adverse events were recorded at visits. The primary efficacy endpoint was the MDS-UPDRS part III scores change from baseline to 12 months.

Secondary efficacy endpoints were the change in scores on MDS-UPDRS part III at six months, change in scores on MDS-UPDRS parts I, II, and IV at six and 12 months, and change in total MDS-UPDRS score at 12 months. Efficacy was assessed using Student’s t-test.

Linear regression analyses investigated the potential effects of baseline levels of fasting blood glucose and insulin on the primary endpoint.

Findings

The study enrolled 156 subjects; seventy-eight were assigned to receive lixisenatide, and the remainder were assigned to the placebo group. In the lixisenatide arm, 28 subjects were switched back to the 10 μg/day dose due to side effects at the 20 μg/day dose.

Further, dose reduction was required for three placebo recipients. Adherence to the trial agent was over 92% at all visits.

Participants’ baseline clinical and demographic characteristics were similar between groups. In both groups, the average time from diagnosis was 1.4 years.

The average baseline MDS-UPDRS motor score was 14.8 in lixisenatide subjects and 15.5 in placebo recipients. At 12 months, these scores were 14.9 and 18.8 in the lixisenatide and placebo groups, respectively.

Lixisenatide recipients improved their score by 0.04 points from baseline, while placebo subjects had worsened it by 3.04 points. At 14 months, these scores were 17.7 and 20.7 in the lixisenatide and placebo groups, respectively.

Results for secondary/exploratory measures were similar between groups at six and 12 months. No associations were observed between fasting blood glucose and insulin levels at baseline and MDS-UPDRS part III score at 12 months.

Most participants had at least one adverse event. Gastrointestinal side effects were more prevalent with lixisenatide.

The two groups had a similar incidence of serious adverse events. One serious adverse event, syncope in placebo recipients and pancreatitis in the lixisenatide group was deemed treatment-related.

Conclusions

In sum, this phase 2 trial showed that lixisenatide, administered in an on-medication state, had a three-point improvement on a motor disability scale over 12 months compared to baseline.

This difference was driven by an increase in scores in placebo recipients. Further, a three-point between-group difference in the motor score was observed after the two-month washout period, favoring active treatment.

Notably, the trial involved subjects with early disease; as such, it has to be investigated whether drug effects persist at other stages of the disease.

Moreover, secondary endpoints did not definitively support primary endpoint results; therefore, longer washout periods may be necessary to test if the drug has long-lasting effects.
Journal reference:

Meissner WG, Remy P, Giordana C, et al. (2024) Trial of Lixisenatide in Early Parkinson’s Disease. N Engl J Med,. doi: 10.1056/NEJMoa2312323.
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April 18, 2024
Study reveals long-term consequences of atrial fibrillation

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The lifetime risk of atrial fibrillation (a heart condition that causes an irregular and often abnormally fast heart rate) has increased from one in four to one in three over the past two decades, finds a study from Denmark in The BMJ today.

And among those with the condition, two in five are likely to develop heart failure over their remaining lifetime and one in five encounter a stroke, with little or no improvement in risk evident over the 20 year study period.

As such, the researchers say stroke and heart failure prevention strategies are needed for people with atrial fibrillation.

Atrial fibrillation is estimated to affect 18 million people in Europe by 2060 and 16 million people in the US by 2050. In the English NHS alone, more new cases of atrial fibrillation are diagnosed each year than the four most common causes of cancer combined, and direct expenditure on atrial fibrillation has reached £2.5 billion.

Once atrial fibrillation develops, patient care has primarily focused on the risk of stroke, but other complications such as heart failure and heart attack have yet to be fully explored.

To address this knowledge gap, researchers analysed national data for 3.5 million Danish adults with no history of atrial fibrillation at age 45 or older to see whether they developed atrial fibrillation over a 23 year period (2000-22).

All 362,721 individuals with a new diagnosis of atrial fibrillation during this time (46% women and 54% men) but with no complications, were subsequently followed until a diagnosis of heart failure, stroke or heart attack.

Potentially influential factors such as history of high blood pressure, diabetes, high cholesterol, heart failure, chronic lung and kidney disease, family income and educational attainment, were also taken into account.

The results show that the lifetime risk of atrial fibrillation increased from 24% in 2000-10 to 31% in 2011-22. The increase was larger among men and individuals with a history of heart failure, heart attack, stroke, diabetes, and chronic kidney disease.

Among those with atrial fibrillation, the most common complication was heart failure (lifetime risk 41%). This was twice as large as the lifetime risk of any stroke (21%) and four times greater than the lifetime risk of heart attack (12%).

Men showed a higher lifetime risk of complications after atrial fibrillation compared with women for heart failure (44% vs 33%) and heart attack (12% vs 10%), while the lifetime risk of stroke after atrial fibrillation was slightly lower in men than women (21% vs 23%).

Over the 23-year study period, there was virtually no improvement in the lifetime risk of heart failure after atrial fibrillation (43% in 2000-10 vs 42% in 2011-22) and only slight (4-5%) decreases in the lifetime risks of any stroke, ischaemic stroke, and heart attack after atrial fibrillation, which were similar among men and women.

This is an observational study, so no firm conclusions can be drawn about cause and effect, and the authors acknowledge that they may have missed patients with undiagnosed atrial fibrillation. Nor did they have information on ethnicity or lifestyle factors, and say results may not apply to other countries or settings.

But despite these caveats, they conclude: “Our novel quantification of the long term downstream consequences of atrial fibrillation highlights the critical need for treatments to further decrease stroke risk as well as for heart failure prevention strategies among patients with atrial fibrillation.”

Interventions to prevent stroke have dominated atrial fibrillation research and guidelines during this study period, but no evidence suggests that these interventions can prevent incident heart failure, say UK researchers in a linked editorial.

They call for alignment of both randomized clinical trials and guidelines “to better reflect the needs of the real-world population with atrial fibrillation” and say this robust observational research “provides novel information that challenges research priorities and guideline design, and raises critical questions for the research and clinical communities about how the growing burden of atrial fibrillation can be stopped.”

Source:

Journal reference:

Vinter, N., et al. (2024). Temporal trends in lifetime risks of atrial fibrillation and its complications between 2000 and 2022: Danish, nationwide, population based cohort study. BMJ. doi.org/10.1136/bmj-2023-077209.

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April 18, 2024
Global disease burden study highlights COVID-19 impact and health inequities

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Rates of early death and poor health caused by HIV/AIDS and diarrhea have been cut in half since 2010, and the rate of disease burden caused by injuries has dropped by a quarter in the same time period, after accounting for differences in age and population size across countries, based on a new study published in The Lancet. The study measures the burden of disease in years lost to early death and poor health. The findings indicate that total rates of global disease burden dropped by 14.2% between 2010 and 2019. However, the researchers found that the COVID-19 pandemic interrupted these downward trends: rates of disease burden increased overall since 2019 by 4.1% in 2020 and by 7.2% in 2021. This is the first study to measure premature death and disability due to the COVID-19 pandemic globally and compare it to other diseases and injuries.

The study reveals how healthy life expectancy, which is the number of years a person can expect to live in good health, rose from 61.3 years in 2010 to 62.2 years in 2021. Pinpointing the factors driving these trends, the researchers point to rapid improvements within the three different categories of disease burden: communicable, maternal, neonatal, and nutritional diseases; non-communicable diseases; and injuries. Among communicable, maternal, neonatal, and nutritional diseases, the burden of disease declined for neonatal disorders (diseases and injuries that appear uniquely in the first month of life), lower respiratory infections, diarrhea, malaria, tuberculosis, and HIV/AIDS between 2010 and 2021, ranging from reductions of 17.1% for neonatal disorders to 47.8% for HIV/AIDS. In the category of non-communicable diseases, disease burden from stroke dropped by 16.9%, while disease burden from ischemic heart disease fell by 12.0% during this period.

For injuries, the years of healthy life lost due to road injuries was slashed by nearly a quarter (22.9%), while disease burden from falls was reduced by 6.9%. Progress in reducing disease burden varied by countries’ Socio-demographic Index – a measure of income, fertility, and education – underscoring inequities. For example, the burden of disease due to stroke dropped by 9.6% from 2010 to 2021 in countries with the lowest Socio-demographic Index, but it declined faster – by 24.9% – among countries with higher Socio-demographic Index.

Our study illuminates both the world’s successes and failures. It demonstrates how the world made huge strides in expanding treatment for HIV/AIDS and combatting vaccine-preventable diseases and deaths among children under 5. At the same time, it shows how COVID-19 exacerbated inequities, causing the greatest disease burden in countries with the fewest resources, where health systems were strained and vaccines were difficult to secure. Governments should prioritize equitable pandemic preparedness planning and work to preserve the momentum that we’ve seen in improving children’s health.”

Dr. Alize Ferrari, Affiliate Associate Professor at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Honorary Associate Professor at the School of Public Health at the University of Queensland, and co-first author of the study

The research presents updated estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021. The GBD 2021 study analyzes incidence, prevalence, years lived with disability (years lived in less-than-ideal health), and disability-adjusted life years (lost years of healthy life) at global, regional, national, and subnational levels. It presents estimates of health and health loss in age-adjusted rates and total rates per 100,000 people. The study provides globally comparable measures of healthy life expectancy and is the first study to fully evaluate burden of disease amid the first two years of the COVID-19 pandemic. COVID-19 was the single leading cause of disease burden worldwide in 2021, accounting for 7.4% of total disease burden globally.

The study also examined how the COVID-19 pandemic affected males and females differently. The researchers found that males were more likely than females to die of COVID-19; the age-standardized disease burden rate for COVID-19 among males was nearly twice that of females. However, the secondary effects of the COVID-19 pandemic, including long COVID and mental disorders, hit females hardest. For example, females were twice as likely as males to develop long COVID. Depression, which increased sharply during the pandemic, was most likely to affect females between ages 15 and 65. Looking at differences between age groups, COVID-19 caused the most disease burden in older adults. For COVID-19, adults 70 years and older had more than double the levels of disease burden compared to adults between the ages of 50 and 69.

The study highlights not only the diseases and injuries that cut life short and cause poor health, and how the burden of disease from different causes has changed over time, but also examines how these patterns differ across countries and regions. “In essence,” the authors write, the study “provides a comprehensive toolkit to inform and enhance decision-making processes across various levels of governance and practice.”

GBD 2021 shines a light on the different causes of disease burden, showing which ones have improved and which are stagnating or worsening. It also tallies the number of years that people are living healthy lives. Healthy life expectancy rose significantly in 59 countries and territories between 2010 and 2021, with the greatest improvements in countries ranking lowest on the Socio-demographic Index, jumping from 52.2 years in 2010 to 54.4 years in 2021. In contrast, healthy life expectancy showed minimal change among countries in the highest levels of the Socio-demographic Index, decreasing slightly from 68.9 years in 2010 to 68.5 years in 2021. The findings on healthy life expectancy demonstrate that even though people are living longer lives all over the world, they aren’t spending all those years in good health. The researchers found that the main causes of poor health were low back pain, depressive disorders, and headache disorders.

“With low back pain, the leading cause of poor health globally, we see that the existing treatments aren’t working well to address it,” said Dr. Damian Santomauro, Affiliate Assistant Professor of Health Metrics Sciences at IHME; Stream Lead at Queensland Centre for Mental Health Research; Adjunct Fellow at the School of Public Health at the University of Queensland; and co-first author of the study. “We need better tools to manage this major cause of global disease burden.”

“In contrast, for depressive disorders, we know what can work: therapy, medication, or both in combination for an adequate period of time. However, most people in the world have little or no access to treatment, unfortunately,” he said. “Considering how depression increased dramatically during the COVID-19 pandemic, it’s urgent to ensure that everyone with this disorder can get treatment.”

Another way to understand what is making people ill is by looking at which diseases are growing fastest. GBD 2021 reveals that diabetes experienced the most rapid growth among the different causes of poor health, what the researchers call years lived with disability. Age-adjusted years lived with disability due to diabetes rose by 25.9% between 2010 and 2021. Poor health from diabetes increased in every country and territory that the researchers studied.

“Diabetes is a major contributor to stroke and ischemic heart disease, which are among the top three causes of disease burden worldwide,” said Dr. Theo Vos, Professor Emeritus at IHME and one of the study’s senior authors. “Without intervention, more than 1.3 billion people in the world will be living with diabetes by 2050. To counter the threat of diabetes, we must ensure that people in all countries can access preventive care and treatment, including to anti-obesity medications, which can lower a person’s risk of developing diabetes.”

Source:

Institute for Health Metrics and Evaluation

Journal reference:

GBD 2021 Diseases and Injuries Collaborators., (2024) Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. The Lancet. doi.org/10.1016/S0140-6736(24)00757-8.

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April 18, 2024
1 in 5 older Canadian adults with diabetes developed functional limitations during the pandemic

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Researchers found that approximately 1 in 5 older Canadian adults with diabetes and no pre-pandemic functional limitations developed functional limitations for the first time during the COVID-19 pandemic. Functional limitations refer to difficulties with basic mobility-related tasks, such as walking two to three blocks, standing up from a chair, or climbing stairs. In comparison, only one in eight of their peers without diabetes developed functional limitations during the pandemic.

Functional status is an important predictor of longevity and quality of life among older adults, and individuals with diabetes face a higher risk of functional decline than the general population. Because the pandemic exacerbated many risk factors for functional decline, such as social isolation and physical inactivity, we wanted to examine changes in functional status among this population.”

Andie MacNeil, first author, research assistant at the Factor-Inwentash Faculty of Social Work (FIFSW) and the Institute for Life Course and Aging at the University of Toronto

The study’s sample came from the Canadian Longitudinal Study on Aging, a national longitudinal study of older Canadians. Respondents with diabetes were 53% more likely to develop at least one functional limitation during the pandemic compared to respondents without diabetes. Even after taking into account major risk factors for functional decline, such as such as physical activity, obesity, smoking, and other chronic health conditions, older adults with diabetes still faced a 28% higher risk of developing functional limitations.

“It is important for health professionals to encourage their older patients, particularly those with diabetes, to engage in behaviours that can help maintain their functional status, such as regular physical activity,” said co-author Susanna Abraham Cottagiri, doctoral candidate at the School of Medicine at Queens University.”

The study also found that socioeconomic factors were associated with functional limitations among older adults with and without diabetes. When compared to those with an annual household income of $100,000 or more, older adults with diabetes with an income of $20,000 or less had a 5-fold higher risk of developing at least one functional limitation. Even among those without diabetes, those with an income of $20,000 or less had double the risk of developing at least one functional limitation compared to those with an annual income of $100,000 or more.

“While socioeconomic status is an important predictor of functional decline among those both with and without diabetes, the magnitude of this relationship is much greater for respondents with diabetes,” said co-author Ying Jiang, a senior epidemiologist at the Public Health Agency of Canada.

The authors also examined the probabilities of functional limitations across various patient characteristics such as sex, diabetes status, and household income, and then stratified into several risk factors, such as age, physical activity level, smoking status, multimorbidity, and weight. Across various patient profiles, socioeconomic status was a consistent driver of functional status.

Co-author Professor Paul Villeneuve at the Department of Neuroscience and the CHAIM Research Centre, Carleton University, hypothesized the possible reason for this pattern: “People with low socioeconomic status face disproportionate stressors over their lifetime that may adversely impact their physical functioning in older age, such as working more physically demanding jobs, worse nutrition, and living in areas with less greenspace and walkability.”

The researchers hope these findings can be used to inform interventions to promote better physical functioning among middle age and older adults.

“Combining lifestyle approaches that integrate physical activity with nutrition interventions have been shown to improve physical function in older adults with diabetes” said co-author Margaret de Groh, scientific manager at the Public Health Agency of Canada.

“Poverty remains a major barrier to nutrition and food security,” said senior author Professor Esme Fuller-Thomson at the University of Toronto’s FIFSW and director of the Institute for Life Course & Aging. “It is important to think about broader strategies to decrease poverty and improve food access in Canada in order to promote better physical functioning among older adults.”

The study was published this week in the Canadian Journal of Diabetes. The study included 6,045 participants of the Canadian Longitudinal Study on Aging (CLSA) who were free from functional limitations in the 2015-2018 wave of data collection and who provided information on their functional status during the COVID-19 pandemic (September–December 2020). This research was supported, in part, by the Canadian Institutes of Health Research (CIHR) grant #172862 (PI Esme Fuller-Thomson).

Source:

Journal reference:

MacNeil, A., et al. (2024) Incident Functional Limitations Among Older Adults With Diabetes During the COVID-19 Pandemic: An Analysis of Prospective Data From the Canadian Longitudinal Study on Aging. Canadian Journal of Diabetes. doi.org/10.1016/j.jcjd.2024.02.005.

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April 17, 2024